[Primary Prevention in General Medical Practice: A Survey]. / Primärprävention in der Allgemeinarztpraxis: Eine Befragung.

AIM OF THE STUDY: According to the German social insurance code §20 Sec. 1, statutory health insurance companies can reimburse up to 80% of costs incurred by primary prevention programs in physical activity, nutrition, stress management and drug consumption. Whether and how many general practitioners (GPs) provide their patients with information on such programs as part of their own practice is unknown. In this study, we investigate to which primary prevention programs primary care physicians refer their patients and whether they take into account reimbursability of programs. METHODS: Between November 2010 and February 2011, all GPs with a practice in Berlin (n=1 168) received a questionnaire that assessed if patients were referred to prevention programs and the type of programs they were referred to, if they ensured they are reimbursable and if they themselves offered prevention programs. Descriptive statistics and multivariate logistic regression was used for analysis. RESULTS: Of 474 respondents (response rate: 41%), 67% were female. Of the respondents, 22% offered reimbursable prevention programs and 42% at out-of-pocket expense. Patients were referred to reimbursable programs by 63%. GPs younger than 50 were twice as likely to offer reimbursable programs in their practice compared to those older than 50 (OR=1.7; 95% KI 1.1-2,8; p-value 0.025). CONCLUSION: A successful implementation of the new German prevention law needs awareness among GPs about reimbursable prevention programs, which may be lacking in some groups.

High-resolution atomic force microscopy as a tool for topographical mapping of surface budding.

Extracellular vesicles (EVs) are membranous nanoparticles secreted by almost all cell types. Reflecting the physiopathological state of the parental cell, EVs circulate in all body fluids, reaching distant cell targets and delivering different bioactive cargoes. As biological carriers, EVs influence their microenvironment altering cellular responses, being considered promising biomarkers for both physiological and pathological conditions. EVs are heterogeneous in terms of size and composition, depending on cell type and exposure to stimuli, and different methods have been developed to characterize their morphological, biophysical, and biochemical features. Among them, electron microscopy (EM) is the main technique used, however, the lack of standardized protocols makes it difficult to characterize EVs with a good reproducibility, thus using multiple approaches may represent a way to obtain more precise information. Furthermore, the relationship between architecture and function, not only in a molecular, but also in a cellular level, is gaining growing emphasis, characterizing morphometric parameters may represent a distinct, but effective approach to study the physiopathological state of the cell. Atomic force microscopy (AFM), may represent a promising method to study in detail EVs dynamics throughout the cell surface and its variations related to the physiological state, overcoming the limits of EM, and providing more reliable information. In this study, human neuroblastoma SH-SY5Y cell line, a cellular model to investigate neurodegeneration and oxidative stress, has been used to perform a comparative morphological and quantitative analysis of membrane budding and isolated large vesicles-enriched (microvesicles-like vesicles; MVs) fraction from control or oxidative stressed cells. Our main goal was to build up a methodology to characterize EVs morphology and spatial distribution over the cell surface in different physiological conditions, and to evaluate the efficacy of AFM against conventional EM. Interestingly, both microscopy techniques were effective for this analysis, but AFM allowed to reveal a differential profiling of plasma membrane budding between the physiological and the stress condition, indicating a potential relationship between mechanical characteristics and functional role. The results obtained may provide interesting perspectives for the use of AFM to study EVs, validating a morphometric approach to understand the pathophysiological state of the cell related to EVs trafficking.

Microvesicles and exosomes in metabolic diseases and inflammation.

Metabolic diseases are based on a dysregulated crosstalk between various cells such as adipocytes, hepatocytes and immune cells. Generally, hormones and metabolites mediate this crosstalk that becomes alterated in metabolic syndrome including obesity and diabetes. Recently, Extracellular Vesicles (EVs) are emerging as a novel way of cell-to-cell communication and represent an attractive strategy to transfer fundamental informations between the cells through the transport of proteins and nucleic acids. EVs, released in the extracellular space, circulate via the various body fluids and modulate the cellular responses following their interaction with the near and far target cells. Clinical and experimental data support their role as biomarkers and bioeffectors in several diseases includimg also the metabolic syndrome. Despite numerous studies on the role of macrophages in the development of metabolic diseases, to date, there are little informations about the influence of metabolic stress on the EVs produced by macrophages and about the role of the released vesicles in the organism. Here, we review current understanding about the role of EVs in metabolic diseases, mainly in inflammation status burst. This knowledge may play a relevant role in health monitoring, medical diagnosis and personalized medicine.

Static magnetic field selects undifferentiated myelomonocytes from low-glutamine concentration stimulated U937 cells.

Reduced glutamine (GLN) concentration in the culture medium of a U937 cell line caused them to be differentiated along the monocytic pathway; cells attached to the matrix and to each other by extending pseudopodia and acquired specific functional characteristics, such as the expression of alpha-naphthyl-acetate esterase and the capacity to reduce nitroblue tetrazolium, as well as becoming active phagocytes. When U937 cells were differentiated under continuous exposure to a 6mT static magnetic field (MF) the overall differentiation process was perturbed. Surprisingly, after 5 days' exposure to the static MF, higher cell viability and differentiation were observed in cells cultured in a GLN-deprived medium than in cells grown in the same medium but in the absence of a static MF. The latter cells, particularly those that were still floating in the medium, were stimulated with TPA for a further 3 days. These cells differentiated and attached to the substrate. Conversely, the same treatment applied to cells cultured in GLN-deprived medium in the presence of the static MF resulted in resistance to TPA-induced differentiation. Indeed, these cells exhibited a round shape and in-suspension growth.

Cystamine potently suppresses in vitro HIV replication in acutely and chronically infected human cells.

We have investigated the effects of cystamine on the replication of human immunodeficiency virus (HIV) in human lymphocytes and macrophages, the natural targets of HIV in vivo. Treatment of chronically infected macrophages with cystamine, at a concentration (500 microM) that did not show any cytotoxic or cytostatic effects, strongly decreased (> 80%) HIV-p24 antigen production and completely abolished the production of infectious viral particles. Cystamine does not affect viral transcription, translation or protein processing; indeed, all HIV proteins are present in a pattern similar to that of nontreated cells. Instead, cystamine interferes with the orderly assembly of HIV virions, as shown by electron microscopy analysis, that reveals only defective viral particles in treated cells. Moreover, suppression of HIV replication, due to the inhibition of proviral DNA formation was observed in acutely infected lymphocytes and macrophages pretreated with cystamine. These results show that cystamine potently suppresses HIV replication in human cells by contemporaneously blocking at least two independent steps of the viral life cycle, without affecting cell viability, suggesting that this compound may represent a new possibility towards the treatment of HIV-1 infection.

Proteinaceous diet inhibits gossypol-induced spermatotoxicity.

The present study was designed to investigate the effect of a proteinaceous dietary supplement, fishmeal, on gossypol-induced spermatotoxicity. Twenty-five adult male Wistar rats, averaging 205 g b.w., were randomly sorted into four experimental groups (I-IV) of 5 animals each, and a control group. Crude cottonseed oil was administered orally to each animal in groups I-IV at a rate that provided 14 mg/kg/d free gossypol; in addition, 3 g/d, 7 g/d, and 10 g/d of fishmeal was provided as meal supplement to each animal in groups I, II and III respectively. The control group received rat pellets and water freely. At the end of the 53-day treatment period, all animals were placed under chloroform anaesthesia; the caudal epididymides were removed, minced and placed in Ham's F10 solution for the evaluation of sperm count and motility. The testes were also processed for histological studies using the eosin and haematoxylin (H & E) method. Our findings revealed a dose-dependent inhibition of gossypol-induced spermatotoxicity by the supplemented fishmeal; this suggests that proteinaceous diets are protective against gossypol-induced male infertility.

Size and stability of dipalmitoylphosphatidylcholine/cholesterol unilamellar vesicles are affected by interaction with proteins.

The effect of entrapping the enzyme ascorbate oxidase into dipalmitoylphosphatidylcholine/cholesterol vesicles, was studied by conventional transmission electron microscopy and freeze-fracture. The freeze-fracture technique has definitely demonstrated the unilamellar nature of empty and enzyme-loaded vesicles. Images of freeze-fractured and label-fractured liposomes also indicate that the observed reduction of vesicles volume could be related to the localization of ascorbate oxidase across the membrane. The membrane localization of ascorbate oxidase may explain the oxidation of externally added ascorbate by intact enzyme-loaded liposomes. Finally, the ageing of liposomes appears to be accelerated in the presence of proteins.

Localization and interaction of bovine pancreatic trypsin inhibitor and tryptase in the granules of bovine mast cells.

The interaction of bovine pancreatic trypsin inhibitor and bovine tryptase, isolated from liver capsule mast cells, was investigated. They form a complex in vitro with a Ki of 5.6 nM at pH 8.0 and are localized within the mast cell granules, as shown by immunogold staining at the electron microscope level. In addition, double immunogold electron microscopy revealed that the inhibitor and the enzyme are present in the same granules, where they occur in clusters; this may be taken as an indication of their interaction in vivo and suggests a physiological role for bovine pancreatic trypsin inhibitor in the regulation of tryptase proteolytic activity.

Insulin effect on isolated rat hepatocytes: diacylglycerol-phosphatidic acid interrelationship.

It is widely accepted that insulin action does not involve inositol phospholipid hydrolysis through the stimulation of a phosphatidylinositol-specific phospholipase C (PI-PLC). This consideration prompted us to investigate the insulin effect on the mechanism leading to the accumulation of diacylglycerol (DAG) and phosphatidic acid (PA) in rat hepatocytes. Basically, insulin induces: (i) a significant increase of both [3H]glycerol and fatty acid labelling of DAG; (ii) a significant increase of PA labelling preceding DAG labelling and paralleled by a decrease of phosphatidylcholine (PC) labelling. These observations, which suggest an insulin-dependent involvement of a phospholipase D, are strengthened by the increase of PC-derived phosphatidylethanol in presence of ethanol. Finally, the observation that the PA levels do not return to basal suggests that other mechanisms different from PC hydrolysis, such as the stimulation of direct synthesis of PA, may be activated.

Insulin binding and internalization in rat hepatocytes during prenatal and postnatal life.

Insulin binding to isolated rat hepatocytes was studied during prenatal and postnatal life. Results show that in hepatocytes isolated from prenatal, postnatal and adult rat there is a constant increase in the number of insulin binding sites per cell, whereas the affinity of plasma membrane receptors for the hormonal ligand remains unaltered from prenatal to adult hepatocytes. Autoradiographic studies indicate a greater internalization of hormone during prenatal life and, taking into account the increase of cell size, suggest an unchanged surface density of receptor sites before and after birth.

In vivo and in vitro induction of 'tissue' transglutaminase in rat hepatocytes by retinoic acid.

Tissue transglutaminase (tTG) expression was found to be induced in rat liver following in vivo retinoic acid (RA) treatment (Piacentini et al. (1988) Biochem. J. 253, 33-38). Here we show that the increased enzyme expression in rat liver is at least partially the result of the action of RA in parenchymal cells. In fact, (a) when hepatocytes are isolated from RA-treated animals their transglutaminase protein content is much higher than in similarly isolated control cells; (b) higher tTG protein level is also found by immunoelectronmicroscopy in the hepatocytes of the RA-treated rats as compared with the very low amount detected in the controls; (c) RA induces tTG in hepatocytes under culture conditions as well. One of the functions of tTG is to form a protein polymer in dying apoptotic cells by epsilon(gamma-glutamyl)lysine and, specifically gamma-glutamylpolyamine cross-links (Fesus et al. (1989) FEBS Lett. 245, 150-154). Noteworthy, after in vivo and in vitro RA-treatment we could not determine any increase (there was even a slight decrease) in the number of the cross-linked apoptotic envelopes. In keeping with this is the significant reduction of protein bound gamma-glutamylpolyamine detected in hepatocytes exposed to RA in culture. These findings suggest that the RA-induced tTG in parenchimal cells is an inactive form.

In vitro study of the interaction of polyalkilimide and polyvinyl alcohol hydrogels with cells.

Hydrogels are a class of polymers that in the last decade have had a great development and application for soft tissue augmentation, due to their similarity to this tissue for their high water content. The in vitro effects of polyalkylmide hydrogel (pAI) and polyvinyl alcohol hydrogel (pVOH) on human lymphocytes and U937 cells viability, apoptosis and cell shape were investigated. Cell viability was always higher than 70%, thus showing the hydrogels were not cytotoxic for both cell lines. Some differences were, however, found. At short time, lymphocytes were very sensitive to the hydrogels incubation, while at long time, U937 cells were the most sensitive cells. Other differences on cell viability were related to the time of incubation, to the type of hydrogel and to the polymers concentration. Cell viability decreased only at the longest time of incubation and with the highest hydrogel concentration. Accordingly, cell death by apoptosis increased; necrosis was never observed in the cultures. Concentration- and hydrogel-dependent modifications of cell shape (bigger cell volume, elongations of cells) were observed in a few percentage of viable cells. In conclusion, the very high in vitro degree of biocompatibility shown by both hydrogels encourages their use as dermal fillers.

In vitro and in vivo biocompatibility evaluation of a polyalkylimide hydrogel for soft tissue augmentation.

Injectable fillers are commonly used in Plastic and Reconstructive Surgery to correct serious and slight aesthetic defects due to their low invasiveness and an easy implant technique procedure. Synthetic hydrogels are proposed as filler materials for their similarity with soft tissue and to avoid many disadvantages of naturally derived materials such as short persistence, allergenicity, and immunogenicity. Our studies are focused on the biocompatibility evaluation of a polyacrylic hydrogel containing alkylimide-amide groups and pyrogen free water (96%) (Bio-Alcamid by means of the in vitro cytotoxicity and mutagenicity assays and the in vivo skin irritation, sensitization test, and subcutaneous implant. All tests conducted on Bio-Alcamid showed no toxicity. It is a substance easy to inject and remove; it does not migrate, and its safety allows it to be a suitable filler for the correction of slight and also very serious aesthetic defects.

Differentiation of monocytic U937 cells under static magnetic field exposure.

We present here a morphological, cytochemical and biochemical study of the macrophagic differentiation of human pro-monocytic U937 cells exposed to moderate intensity (6 mT) static magnetic fields (MF). It was found that the following substances induced differentiation in U937 cells to a progressively lower degree: 50 ng/mL 12-0-tetradecanoyl-13-phorbol acetate (TPA), low concentration of glutamine (0,05 mM/L), 10% dimethyl sulfoxide (DMSO) and 100 mM/L Zn++. Differentiated U937 cells shift from a round shape to a macrophage-like morphology, from suspension to adhesion growth and acquire phagocytotic activity, the cytoskeleton adapting accordingly. Exposure to static MF at 6 mT of intensity decreases the degree of differentiation for all differentiating molecules with a consequent fall in cell adhesion and increased polarization of pseudopodia and cytoplasmic protrusions. Differentiation alone, or in combination with exposure to static MFs, affects the distribution and quantity of cell surface sugar residues, the surface expression of markers of macrophage differentiation, and phagocytotic capability. Our results indicate that moderate-intensity static MFs exert a considerable effect on the process of macrophage differentiation of pro-monocytic U937 cells and suggest the need for further studies to investigate the in vivo possible harmful consequences of this.

[Astrocytic neoplasms and correlation with mutate p53 and Ki-67 proteins]. / Neoplasias astrocitárias e correlação com as proteínas p53 mutada e Ki-67.

The astrocytic neoplasms respond by 60% of the central nervous system tumors, being the study of the molecular biology an important step for the understanding of the genesis and biological behavior of these diseases. The Ki-67 proteins, which are markers of the cellular proliferation, and p53, which is the product of the tumor suppressor gene TP53, are both important tumoral markers. This study intends to identify and quantify the Ki-67 and p53 proteins in astrocytic tumors of different grades of malignancy, as well as to analyze their relations with age and gender. Ki-67 and p53 proteins in 47 patients with surgically resected astrocytic neoplasms were studied through immunohistochemistry. They have been previously classified and reviewed concerning their histological grade, as suggested by the World Health Organization. The immunomarked cellular nuclei were quantified by the program Imagelab-softium for the absolute parametric reason between the nuclei of the positive cells and the total amount of tumoral cells, being counted 1000 cells. The lineation used has been transversal not controlled. For the statistical analysis the variables were divided into groups. For the Ki-67 they were absent, <5% and >5% and for p53 they were absent (0), <25% (1+), between 25 and 50% (2+), between 50 and 75% (3+), and higher than 75% (4+). Ki-67 was present in 37 cases (78.72%) evidencing a correlation with a higher malignancy degree (p<0,001). p53 was present in 14 cases (35.13%) with a higher correlation with astrocytoma grade IV (p=0.59). There has not been a statistically significant correlation between p53 and Ki-67, as well as among these variables, age and gender. The hypotheses of a greater presence of Ki-67 and p53 in astrocytic neoplasms with a higher degree of malignancy, except for the correlation between grade III and p53, is corroborated by the results of this study.

Quantification and localization of galactose-specific binding sites in rat liver during postnatal development.

We investigated the number and distribution of galactose-specific binding sites in developing livers from suckling rats of various ages using Lac-BSA-Au5 (lactosylated bovine serum albumin adsorbed onto colloidal gold particles 5 nm in diameter) as electron-dense ligand, and performing transmission electron microscopy of the specimen. It has been reported that the number of galactose-specific binding sites increases rapidly during organ development post partum (p.p.) and this was ascribed to hepatocyte receptor increase only. We now have investigated in in situ and in vitro experiments whether the binding sites of identical sugar specificity but located on sinusoidal cells show the same increase in expression or are independently regulated. We therefore quantified the number of particles bound by isolated hepatocytes and liver macrophages and found a gradual increase of both binding activities with age, the binding levels of adult liver cells being reached at day 15 p.p. This was confirmed with experiments using in situ prefixed organs thus proving the validity of this finding also for the intact organ. In both sets of experiments--in vitro as well as in vivo--ligand was found binding statistically distributed as single particles on hepatocytes of all ages, whereas on liver macrophages the binding pattern changed during development. On liver macrophages from rats 15 days of age ligand binding occurs in the preclustered pattern described for macrophages from adult rat livers whereas liver macrophages of newborn rats express a different binding pattern: they bind the ligands mostly as single particles with only few and small microaggregates.(ABSTRACT TRUNCATED AT 250 WORDS)

The interaction of ceruloplasmin with Kupffer cells.

The binding and uptake of ceruloplasmin was studied with rat liver cells using gold-labeled probes. Ceruloplasmins from either rat or sheep were used, in which different molecular conformations had been induced according to established biochemical criteria. The native protein from either species could bind not only to the endothelium, but also to Kupffer cells, at variance with previous findings. The proteins which had been converted to the conformation typical of stored molecules--which can be considered aged, but not denatured, according to standard activity and spectroscopic assays--were bound by endothelium irrespective of species, while only rat ceruloplasmin was able to bind to rat Kupffer cells. Internalization of sheep ceruloplasmin occurred with either endothelium or Kupffer cells. This property was lost with isolated suspended Kupffer cells. These findings suggest the presence of receptors for ceruloplasmin on Kupffer cells which are different from those present on endothelial cells.

Galactose-specific receptor modulation related to the onset of apoptosis in rat liver.

The expression of the asialoglycoprotein receptor of hepatocytes and the galactose-specific receptors of non-parenchymal liver cells during the onset of apoptosis in liver of rats treated with lead nitrate was studied. During the involution of lead nitrate-induced hyperplasia in rat liver (occurring at 5 days after the injection) a significant increase of asialoglycoprotein receptor (ASGP-R) expression on hepatocytes coincided with the massive death by apoptosis of the same cells. The increase in the receptor expression was sustained by a large increase in the level of its specific mRNA. As a consequence of lead nitrate injection, we also detected a drastic change of the galactose-specific receptor expression and distribution on the surface of rat liver sinusoidal cells. However, the modulation of the receptor expression on the Kupffer cells did not parallel that observed for the ASGP-R: the peak of surface expression measured on hepatocytes always followed the one observed on Kupffer cells. Our data show a first evidence of a receptor modulation during the process of apoptosis. In fact, the entire carbohydrate recognition system of the liver is modulated during the onset of apoptosis induced by lead nitrate injection, but the pattern of modulation depends on the cellular types. We suggest that a physiological role for the hepatic carbohydrate recognition systems is related to the apoptosis of liver.

The clearance of apoptotic cells in the liver is mediated by the asialoglycoprotein receptor.

Apoptosing cells are actively phagocytosed in parenchymal tissues, thus preventing the inflammatory reaction which could derive from their slow uncontrolled degradation. The molecular mechanisms by which an apoptotic cell is recognized and taken up are largely unknown. We propose that the recognition of apoptotic hepatocytes is mediated by the sugar recognition systems of the liver, particularly the asialoglycoprotein receptor (ASGP-R). The results presented here demonstrated the participation of ASGP-R in the removal of apoptotic parenchymal cells, and indicate a new perspective for the understanding of its physiological role.

Age-related changes in the galactose recognition system in rat liver cells.

In the present report, the galactose recognition system in 3- and 24-month-old rat livers has been studied with in vitro and with in situ binding experiments and in vivo ligand uptake. The galactose-specific receptors were visualized by using colloidal gold particles of different sizes (5 nm, 17 nm and 50 nm mean diameter), coated with lactosylated bovine serum albumin (LacBSA) as electron dense ligands. The data show that aging affects the expression of galactose-specific receptors and the rate of endocytosis. In the in vitro and in situ experiments hepatocytes and liver macrophages from old rats on the plasma membrane express a decreased number of binding sites with respect to those present on the adult rat liver cells. Approximately 80% of the total number of liver macrophages from aged rats show a binding distribution which is very different from the typical clustered receptor arrangement: the binding sites appear as single or small clusters of gold granules. As a direct consequence of the altered pattern of the receptor distribution, the capacity of liver macrophages from 24-month-old rats to internalize the larger ligands (17 nm and 50 nm) is decreased, as compared with adult rats. Aging, therefore, influences the galactose recognition system in two ways: (i) by decreasing the number of binding sites expressed on the liver cell surfaces; and (ii) by modifying the receptor distribution on liver macrophages and consequently affecting the internalization of galactose exposing particles.